Home-based Rehabilitation Services Research Articles

Translating acceptability to sustained delivery: Clinician and manager perspectives on implementing modified constraint-induced movement therapy in an early-supported discharge rehabilitation service.

Modified constraint-induced movement therapy (mCIMT) improves upper limb (UL) function after stroke. Despite up to one-third of stroke survivors being eligible, clinical uptake remains poor. To address this, a multi-modal behaviour change intervention was implemented across a large seven-site early-supported discharge (ESD) rehabilitation service. This study investigated the acceptability of mCIMT implementation within this ESD service and identified adaptations required for sustained delivery. This qualitative study was nested within a mixed-methods process evaluation of mCIMT implementation. Four focus groups (n= 24) comprising therapists (two groups), therapy assistants (one group), and allied health managers (one group) were conducted. Data were analysed using reflexive thematic analysis and mapped to the Theoretical Domains Framework (TDF). Consumers were not directly involved in this study; however, lived experience research partners have helped shape the larger mixed-methods implementation study. Four themes were generated and mapped to the TDF. Factors related to acceptability included interdisciplinary practice in sharing workloads (belief about capabilities), practice opportunities across a range of UL presentations (skills), clinician attitudes influencing patient engagement (optimism), time constraints (belief about consequences), and cognitive overload from multiple systems and processes (memory, attention, and decision-making processes). Factors facilitating sustained delivery included improving stroke survivor education (knowledge), sharing success stories across teams (reinforcement), manager facilitation (social/professional role and identity), and the perception that the ESD setting was optimal for mCIMT delivery (social influences). mCIMT was acceptable in the ESD service, with clinicians feeling a responsibility to provide it. Key adaptations for sustained delivery included ongoing training, resource adaptation, and enhanced patient and carer engagement. Successful implementation and sustained delivery of mCIMT in the ESD service could enhance UL function and reduce the burden of care for potentially hundreds of stroke survivors and their carers. Modified constraint-induced movement therapy (mCIMT) helps improve arm movement after a stroke. However, many stroke survivors do not get this therapy. To fix this, we started a program in a large home-based rehabilitation service. This study looked at how well mCIMT could fit into this service. We also wanted to know what changes were needed to make sure it was regularly provided. We held four group discussions with therapists, therapy assistants, and health managers. A total of 24 people took part. From these discussions, we found several important points. Therapists needed to work together as a team. They also needed to practice mCIMT to get better at delivering it. Therapists having a positive attitude would encourage more stroke survivors to take part. For long-term success, stroke survivors need better education about mCIMT. Managers need to encourage therapists to provide mCIMT. The rehabilitation service should also share their success stories about this therapy to encourage therapists to deliver it and stroke survivors to ask for it. Therapists enjoyed delivering mCIMT in the rehabilitation service. It worked better than other therapies to improve a stroke survivor's arm function. Because of this, they also felt it was their duty to offer mCIMT. Having ongoing training and better resources would help keep mCIMT going. If mCIMT can be provided regularly in this service, it could lead to better arm function and less care needed for many stroke survivors and their carers.

SURVEY ON CAREGIVERS' BURDEN OF CARE PATIENTS WITH CHRONIC STROKE AND CONSIDERATIONS ON THE ROLE OF THEPHYSIOTHERAPIST

Background: Therole of caregivers in the rehabilitation process is crucial, yet the impact of caregiving on their well-beingis not fully understood.This study aims to analyze the psycho-physical load on caregivers of chronic stroke patients, evaluate the variables affecting their health, and assess the significance of physiotherapists in improving patient rehabilitation outcomes. Materials: A sample of 30 chronic strokepatients and their caregivers involving home-based rehabilitation services was examined over eight weeks. The study utilized various scales such as the Short Form Health Survey 36 (SF-36), Barthel Index, Stroke Impact Scale 3.0, Modified Rankin Scale, and Caregiver Burden Inventory to assess the health status of patients and the burden on caregivers before and after the intervention. Results: The study found significant improvements in patient health metrics (SF-36, Barthel Index, Stroke Impact Scale, Modified Rankin Scale) post-rehabilitation. Similarly, a notable reduction in caregiver burden was observed, highlighting the effectiveness of targeted physiotherapy interventions in alleviating the psycho-physical stress on caregivers.

Effect of Early Rehabilitation Services After Discharge on Social Activity Among Chronic Stroke Survivors: A Multicenter Prospective Study

BackgroundSocial inactivity after a stroke leads to adverse outcomes, making social activity after discharge important for chronic stroke survivors. ObjectivesTo investigate the effects of early rehabilitation services after discharge on social activity among chronic stroke survivors. MethodsThe participants were prospectively recruited from three convalescent hospitals. Receipt of early rehabilitation services after discharge for chronic stroke survivors was defined as the utilization of day care or home-based rehabilitation services by the Japanese long-term care insurance system. Social activity was assessed using the Frenchay Activities Index (FAI) premorbid and at 3, 6, and 12 months after discharge. In this study, the outcome was defined as the change in the FAI score from 3 to 12 months after discharge. Multivariate regression analysis was performed to examine the effect of access to rehabilitation on changes in FAI. ResultsNinety stroke survivors (age 67.2 ± 11.6 years, 52 male) were enrolled. The FAI showed improvements by 27.4% and 1.4% from 3 to 12 months after discharge in the rehabilitation and non-rehabilitation groups, respectively. Multivariate regression analysis showed that access to rehabilitation after discharge was positively associated with the FAI change from 3 to 12 months after discharge (B = 30.3, β = 0.38, 95% confidence interval = 11.13–49.47, p = 0.002). ConclusionEarly rehabilitation services after discharge were significantly associated with increased social activity.

A Study on the Introduction of Home-Based Rehabilitation Services for Disabled People: Focusing on Domestic and Foreign Countries Cases

A Study on the Introduction of Home-Based Rehabilitation Services for Disabled People: Focusing on Domestic and Foreign Countries Cases

Home-Based Rehabilitation of the Shoulder Using Auxiliary Systems and Artificial Intelligence: An Overview.

Advancements in modern medicine have bolstered the usage of home-based rehabilitation services for patients, particularly those recovering from diseases or conditions that necessitate a structured rehabilitation process. Understanding the technological factors that can influence the efficacy of home-based rehabilitation is crucial for optimizing patient outcomes. As technologies continue to evolve rapidly, it is imperative to document the current state of the art and elucidate the key features of the hardware and software employed in these rehabilitation systems. This narrative review aims to provide a summary of the modern technological trends and advancements in home-based shoulder rehabilitation scenarios. It specifically focuses on wearable devices, robots, exoskeletons, machine learning, virtual and augmented reality, and serious games. Through an in-depth analysis of existing literature and research, this review presents the state of the art in home-based rehabilitation systems, highlighting their strengths and limitations. Furthermore, this review proposes hypotheses and potential directions for future upgrades and enhancements in these technologies. By exploring the integration of these technologies into home-based rehabilitation, this review aims to shed light on the current landscape and offer insights into the future possibilities for improving patient outcomes and optimizing the effectiveness of home-based rehabilitation programs.

Home-Based Physiotherapy and Rehabilitation in Patients with Idiopathic Pulmonary Fibrosis: A Review.

The objective of the study is to review the studies on home-based pulmonary rehabilitation practices in idiopathic pulmonary fibrosis patients in the last 5 years. Home-based randomized controlled trials in idiopathic pulmonary fibrosis patients published in the PubMed database within the previous 5 years were searched. As a result of the research, a total of 5 articles were included in the study. Five home-based rehabilitation practices used in these articles were reached. Totally, 176 patients were found to have participated in these programs. As a result, patients who have difficulty accessing hospital-based rehabilitation services due to various reasons will benefit from home-based rehabilitation services. However, the content of the home-based program and the method of follow-up and supervision affect the results.

Factors that influence the provision of home-based rehabilitation services for people needing rehabilitation: a qualitative evidence synthesis.

To increase people's access to rehabilitation services, particularly in the context of the COVID-19 pandemic, we need to explore how the delivery of these services can be adapted. This includes the use of home-based rehabilitation and telerehabilitation. Home-based rehabilitation services may become frequently used options in the recovery process of patients, not only as a solution to accessibility barriers, but as a complement to the usual in-person inpatient rehabilitation provision. Telerehabilitation is also becoming more viable as the usability and availability of communication technologies improve. To identify factors that influence the organisation and delivery of in-person home-based rehabilitation and home-based telerehabilitation for people needing rehabilitation. We searched PubMed, Global Health, the VHL Regional Portal, Epistemonikos, Health Systems Evidence, and EBM Reviews as well as preprints, regional repositories, and rehabilitation organisations websites for eligible studies, from database inception to search date in June 2022. SELECTION CRITERIA: We included studies that used qualitative methods for data collection and analysis; and that explored patients, caregivers, healthcare providers and other stakeholders' experiences, perceptions and behaviours about the provision of in-person home-based rehabilitation and home-based telerehabilitation services responding to patients' needs in different phases of their health conditions. DATA COLLECTION AND ANALYSIS: We used a purposive sampling approach and applied maximum variation sampling in a four-step sampling frame. We conducted a framework thematic analysis using the CFIR (Consolidated Framework for Implementation Research) framework as our starting point. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. MAIN RESULTS: We included 223 studies in the review and sampled 53 of these for our analysis. Forty-five studies were conducted in high-income countries, and eight in low-and middle-income countries. Twenty studies addressed in-person home-based rehabilitation, 28 studies addressed home-based telerehabilitation services, and five studies addressed both modes of delivery. The studies mainly explored the perspectives of healthcare providers, patients with a range of different health conditions, and their informal caregivers and family members. Based on our GRADE-CERQual assessments, we had high confidence in eight of the findings, and moderate confidence in five, indicating that it is highly likely or likely respectively that these findings are a reasonable representation of the phenomenon of interest. There were two findings with low confidence. High and moderate confidence findings Home-based rehabilitation services delivered in-person or through telerehabilitation Patients experience home-based services as convenient and less disruptive of their everyday activities. Patients and providers also suggest that these services can encourage patients' self-management and can make them feel empowered about the rehabilitation process. But patients, family members, and providers describe privacy and confidentiality issues when services are provided at home. These include the increased privacy of being able to exercise at home but also the loss of privacy when one's home life is visible to others. Patients and providers also describe other factors that can affect the success of home-based rehabilitation services. These include support from providers and family members, good communication with providers, the requirements made of patients and their surroundings, and the transition from hospital to home-based services. Telerehabilitation specifically Patients, family members and providers see telerehabilitation as an opportunity to make services more available. But providers point to practical problems when assessing whether patients are performing their exercises correctly. Providers and patients also describe interruptions from family members. In addition, providers complain of a lack of equipment, infrastructure and maintenance and patients refer to usability issues and frustration with digital technology. Providers have different opinions about whether telerehabilitation is cost-efficient for them. But many patients see telerehabilitation as affordable and cost-saving if the equipment and infrastructure have been provided. Patients and providers suggest that telerehabilitation can change the nature of their relationship. For instance, some patients describe how telerehabilitation leads to easier and more relaxed communication. Other patients describe feeling abandoned when receiving telerehabilitation services. Patients, family members and providers call for easy-to-use technologies and more training and support. They also suggest that at least some in-person sessions with the provider are necessary. They feel that telerehabilitation services alone can make it difficult to make meaningful connections. They also explain that some services need the provider's hands. Providers highlight the importance of personalising the services to each person's needs and circumstances. This synthesis identified several factors that can influence the successful implementation of in-person home-based rehabilitation and telerehabilitation services. These included factors that facilitate implementation, but also factors that can challenge this process. Healthcare providers, program planners and policymakers might benefit from considering these factors when designing and implementing programmes.

Individualized home-based rehabilitation after stroke in France: a pragmatic study of a community stroke rehabilitation team.

Community stroke rehabilitation teams (CSRT) provide an individualized home-based rehabilitation service to patients recovering from stroke. To examine whether there is an improvement in the social participation of patients who received a rehabilitation program provided by CSRT. The secondary objectives were to show if there is an improvement in the patients' quality of life and a reduction in the caregiver burden. Retrospective cohort study, pragmatic in real-care conditions. The rehabilitation program delivered by the CSRT was adapted to the needs of the patients and caregivers. The outcome questionnaires included: the Frenchay Activity Index (FAI), the Minizarit, the EuroQol EQ5D, and the Barthel Index. The primary outcome measure was the FAI. We included 206 patients followed by the CSRT over the 2018-2020 study period, for whom the primary endpoint was present. The mean age was 66.3 ± 12.7 years, the post-stroke delay was 16.4 ± 32.7 months, and the Barthel index was 66.42 ± 12.6. The duration of the rehabilitation program was on average 162 ± 109 days. We observed a significant improvement in the FAI, from 12.9 ± 10.4 to 17.85 ± 12.4 (p < 0.00001); in the EuroQol, from 57.51 ± 19.96 to 66.36 ± 18.87 (p < 0.00001); in the mini-Zarit, from 2.49 ± 1.75 to 2.06 ± 1.67 (p = 0.0002); and in the Barthel index, from 66.42 ± 12.67 to 84.81 ± 23.70 (p < 0.001). Patients who received a rehabilitation program by the CSRT have an improvement in their social participation, and their informal caregivers have a reduction in their burden.

Analysis of Home-Based Rehabilitation Awareness, Needs and Preferred Components of Elderly Patients with Hip Fracture Surgery in South Korea.

The importance and necessity of home-based rehabilitation with professional and systematic interventions should be considered since home-based rehabilitation has been institutionalized as it is more feasible, cost effective, and even safer than in-hospital rehabilitation in most countries—though not in South Korea. In addition, the need for home-based rehabilitation is increasing due to the increasing number of hip fracture patients and limited capacity of acute hospital rehabilitation. Therefore, the purpose of this study was to investigate the awareness, needs, and preferred components of home-based rehabilitation services after discharge for elderly patients with hip fracture surgery in South Korea. A survey of 98 elderly patients who recently underwent hip fracture surgery was performed using a questionnaire. More than 75% of patients agreed on the need for home-based rehabilitation, even though most had never heard of it. The reason for the need for home-based rehabilitation was that it is possible to receive continuously ongoing treatment (53.0%), and it alleviates the inconvenience of visiting hospitals (27.7%). In addition to this, about 15.7% of patients responded that they could achieve mental comfort. In other words, patients can recover in an emotionally stable environment without the psychological anxiety they might experience in hospital. Thus, in order to maximize the effectiveness of home-based rehabilitation and provide comprehensive guidance including exercise, education, motivational support, and environmental modification, to patients undergoing hip fracture surgery, the component of the rehabilitation program must be developed based upon rehabilitation experts’ knowledge and patients’ value. Additionally, corresponding policies should be established.

Building a smart rehabilitation delivery platform with hybrid matching algorithm based on long-term care plan in Taiwan

The smart rehabilitation care is to use information and communication technology to apply innovative services on patient care activities. In Taiwan, to solve the over lacking problem of rehabilitation treatment service for long-term care patient in general hospitals, the rehabilitation service delivery method has moved from centralised hospital-based treatment to decentralised community- or home-based rehabilitation. Therefore, community- or home-based long-term care patient has created huge amount of needs for rehabilitation service. To create a more efficient and friendly health care service model, this study uses a hybrid matching algorithm to construct a community and home-based smart rehabilitation service mechanism that allows both therapists and patients to find the most suitable service by setting up the matching parameters. This mechanism records rehabilitation activity, user's feedback, and suggestions from rehabilitation practitioners and can provide information to health units for follow-up treatment recommendation to achieve the goal of optimising long-term care service quality.

Building a smart rehabilitation delivery platform with hybrid matching algorithm based on long-term care plan in Taiwan

The smart rehabilitation care is to use information and communication technology to apply innovative services on patient care activities. In Taiwan, to solve the over lacking problem of rehabilitation treatment service for long-term care patient in general hospitals, the rehabilitation service delivery method has moved from centralised hospital-based treatment to decentralised community- or home-based rehabilitation. Therefore, community- or home-based long-term care patient has created huge amount of needs for rehabilitation service. To create a more efficient and friendly health care service model, this study uses a hybrid matching algorithm to construct a community and home-based smart rehabilitation service mechanism that allows both therapists and patients to find the most suitable service by setting up the matching parameters. This mechanism records rehabilitation activity, user's feedback, and suggestions from rehabilitation practitioners and can provide information to health units for follow-up treatment recommendation to achieve the goal of optimising long-term care service quality.

Health-related quality of life improves over the duration of home-based rehabilitation services

Background/Aims Home-based rehabilitation is an alternative to inpatient rehabilitation. There is little research evaluating its effect on health-related quality of life. This study aimed to investigate whether health-related quality of life improves with rehabilitation services provided in the home. Methods A prospective, single-arm, observational study was undertaken, involving 121 patients receiving home-based rehabilitation services. A health-related quality of life questionnaire was completed by participants at the start and completion of services (using the 5-Level EuroQol-5 Dimension instrument) and analysed descriptively. Changes in health-related quality of life were compared using paired sample t-tests. Multivariate regression analyses were undertaken to investigate the effects of various factors (eg age, gender, diagnostic category) on the observed changes in health-related quality of life. Results Improved health-related quality of life was found: more participants reported ‘no’ or ‘slight’ problems at completion than initially, and there were significant increases in index values (P&lt;0.001) and EuroQol Visual Analogue Scale scores (P&lt;0.001). Admission scores, diagnostic group and duration of home-based rehabilitation services influenced health-related quality of life. Conclusions Health-related quality of life improved from start to completion of home-based rehabilitation services. This may reflect natural recovery and/or the effect of the rehabilitation interventions. Health-related quality of life measures, such as the 5-Level EuroQol-5 Dimension instrument, may be useful to evaluate the effect of home-based rehabilitation.

Association of household income with home-based rehabilitation and home help service utilization among long-term home care service users

BackgroundTo examine the association of household income with home-based rehabilitation and home help services in terms of service utilization and expenditures.MethodsA secondary data analysis of cross-sectional design was conducted using long-term care (LTC) insurance claims data, medical claims data, and three types of administrative data. The subjects comprised LTC insurance beneficiaries in Kashiwa city, Japan, who used long-term home care services in the month following care needs certification. Household income was the independent variable of interest, and beneficiaries were categorized into low-income or middle/high-income groups based on their insurance premiums. Using a two-part model, the odds ratios (ORs) and 95% confidence intervals (CIs) for the utilization of home-based rehabilitation and home help services in the month following care needs certification were estimated using logistic regression analysis, and the risk ratios (RRs) of service expenditures were estimated using a generalized linear model for gamma-distributed data with a log-link function.ResultsAmong 3770 subjects, 681 (18.1%) used home-based rehabilitation and 1163 (30.8%) used home help services. There were 1419 (37.6%) low-income subjects, who were significantly less likely to use (OR: 0.813; 95%CI: 0.670–0.987) and spend on (RR: 0.910; 95%CI: 0.829–0.999) home-based rehabilitation services than middle/high-income subjects. Conversely, low-income subjects were significantly more likely to use (OR: 1.432; 95%CI: 1.232–1.664) but less likely to spend on (RR: 0.888; 95%CI: 0.799–0.986) home help services than middle/high-income subjects.ConclusionHousehold income was associated with the utilization of long-term home care services. To improve access to these services, the LTC insurance system should examine ways to decrease the financial burden of low-income beneficiaries and encourage service utilization.

Human Reliability Assessment of Home-Based Rehabilitation

In recent years, the number of patients who have chosen a home-based rehabilitation service has increased significantly. However, no formal human reliability analysis of such service has yet been published. In this article, we aim to develop a novel failure modes and effects analysis (FMEA) based assessment method to analyze human reliability qualitatively and quantitatively for home-based rehabilitation. The software, hardware, environment, liveware, and central liveware model is first used to analyze the potential failures from four interface systems when rehabilitation measures are implemented at home. Various uncertainties in the experts’ assessment information of potential failures are expressed by means of the concept of hesitant 2-tuple linguistic term sets. The score functions are then suggested to determine the risk ranking of failure modes determined in FMEA. Finally, the practical effectiveness of the proposed method is demonstrated through a case study, and the results show that the proposed method is useful, effective, and flexible for human reliability assessment. In addition, the results could help the health care providers to identify the high-risk failure modes during the design and implementation of the rehabilitation plan at home and take appropriate measures in advance to look for alternatives and ensure the safety and effectiveness of the home-base rehabilitation.

Domiciliary Care Service: Factors Influencing Improvement in Activities of Daily Living Among Stroke Survivors

Stroke is a debilitating disease, adding to morbidity and mortality. Home-based rehabilitation has an influence on functional recovery among stroke survivors. This study aimed to determine factors influencing the improvement in activities of daily living (ADL) among stroke survivors after domiciliary care service. A state-wide record-review study using Domiciliary Care Record from health clinics with comprehensive domiciliary care was conducted. A logistic regression (LR) model was performed to assess factors influencing ADL improvement. Improved ADL was defined as obtaining at least 30% improvement on the Modified Barthel Index at the end of the program. From the records review, 72.2% of the participants had improved ADL following domiciliary care service. The mean age of the sample was 68.21 years ( SD = 11.99). The majority were ischemic stroke survivors (81.2%). In the single LR model, the influencing factors of ADL improvement were younger age (odds ratio [OR] = 2.76; p = .004), married (OR = 2.04; p = .018), ischemic stroke type (OR = 6.35; p &lt; .001), less severe stroke (OR = 4.18; p &lt; .001), no previous stroke (OR = 4.24; p &lt; .001), and 9 to 12 home visits (OR = 2.79; p &lt; .006). The multiple LR model showed ischemic stroke type (adjusted odds ratio [Adj. OR] = 5.30; p &lt; .001), less severe stroke (Modified Rankin Scale score = 4; Adj. OR = 3.70; p &lt; .001), and no previous stroke (Adj. OR = 3.51; p = .001) as significant factors when adjusted for other variables. Recognition of these factors associated with the improvement in stroke recovery is beneficial to intensify an optimal stroke care and home-based rehabilitation services.

REHABILITATION SERVICES AMONG STROKE PATIENTS IN KOTA BHARU DISTRICT

Background: Rehabilitation is a crucial component of the continuum of care, which ensures stroke patients have access to the most appropriate health services , when and where they need them. This study describe the different types of dependency levels and rehabilitation services received by stroke patients in after being discharged from hospitals. Materials and Methods: A cross sectional study was conducted among randomly selected 330 stroke patients admitted between January 2014 and December 2015. Patient information sheets were used to extract information on sociodemographic data, clinical characteristics and rehabilitation service received from patients’ medical record. Descriptive analysis was applied using R software. Result: Majority of stroke patients (79%) were referred to primary healthcare team for further rehabilitation at the community level. All bedridden stroke patients received home-based rehabilitation services. Seventy nine (23.9%) patients received domiciliary care services, whereas others received either nursing care visit 121 (36.7%) or outpatient service 130 (39%). Conclusion: All of the stroke patients were equitably managed considering the limitation in resources, practicability, and requirement based on the patients’ dependency levels. Further research is required to explore service outcome such as patients’ satisfaction towards those provided rehabilitation services in guiding the current service provision. Keywords: Rehabilitation, Post-stroke, Stroke, Post-stroke rehabilitation

Can home-based rehabilitation services facilitate rehabilitation transition from hospital to community?

Can home-based rehabilitation services facilitate rehabilitation transition from hospital to community?

Norwegian municipal rehabilitation services in transition

Background: Intending to meet increased demands of health care services due to the demographic change with an increasing elderly population, Norwegian municipalities along with many other western countries over the last couple of years have increased responsibility for providing rehabilitation services. The services include integrated homebased rehabilitation and institution- based rehabilitation services. The purpose of this study: How have workforces from the primary healthcare services experienced an increased responsibility for somatic rehabilitation? Methods: The study was based on qualitative research methods. We conducted five focus-group interviews with 25 participants with professional backgrounds in nursing, health care practitioner, occupational therapy and physiotherapy. In analysis, we used Systematic Text Condensation. Theory: We applied Self-determination Theory as a theoretical perspective to illuminate the impact of the workers’ experience of autonomy, relatedness and competence on their contribution to the ongoing change in the rehabilitation field. Results: The participants from home-based rehabilitation and institution-based rehabilitation expressed diverging level of self-determination and different opportunities of mobilizing competence. All participants described that more clients needed rehabilitation, and perceived an increased focus on home-based rehabilitation. The participants working in rehabilitation institutions experienced that institution-based rehabilitation services were less prioritized, less autonomy and influence on the daily operations, and that their professional competence was not appreciated. They reported a need for increased competence in rehabilitation among clients, the clients’ relatives and collaborators. They expressed multidisciplinary integration within their team and institution, but less connection to other municipal rehabilitation services. Participants working with home-based rehabilitation experienced being involved in the development of services, and that management and other collaborators appreciated their competence. They expressed affiliation to a larger unit than participants from institution- based rehabilitation. They called for improvements of routines, but perceived improved collaboration with other professionals. The identified differences may possibly be explained by lack of integration of institution-based and home-based municipal rehabilitation services when increasing efforts on developing home-based rehabilitation services. Conclusion: We identified different perceptions of influence and mobilizing of competence between informants from homebased and institution-based rehabilitation services that might influence the workers well-being, enthusiasm and motivation for work. Efforts should be made to ensure integration of institution-based rehabilitation in the ongoing development of municipal rehabilitation services and facilitate development of self-determination and mobilization of competence.

Evaluating the impact of a home-based rehabilitation service on older people and their caregivers: a matched-control quasi-experimental study

IntroductionPrevious studies evaluating home-based rehabilitation service (HBRS) merely focused on the period immediately after the patients’ discharge from hospitals. The present study focuses on HBRS that covers clients who have not been recently hospitalized. HBRS aims to meet older clients’ rehabilitation needs and support their caregivers in the community. This study intended to evaluate the impact of HBRS on the older clients’ health outcomes and hospital services utilization, and caregivers’ strain in providing care for clients.MethodsThis study used a matched-control quasi-experimental design with a 3-month follow-up to evaluate HBRS. The health outcome measures used for the older clients included Elderly Mobility Scale, Timed Up and Go test, Modified Barthel Index, Lawton’s Instrumental Activities of Daily Living Scale, Mini-Mental State Examination, and World Health Organization Quality of Life Scale, Short Form, Hong Kong version (WHOQOL-BREF [HK]). Meanwhile, the Caregiver Strain Index was used to measure the caregivers’ caregiving strain. Data on clients’ hospital services utilization 3 and 6 months before and after the study were also collected and evaluated.ResultsThe final sample consisted of 122 pairs of older clients and caregivers who live in a community in Hong Kong. In the follow-up after 3 months, the intervention group showed immensely substantial improvements across all the health outcome measures compared with the control group. The intervention group also demonstrated substantial reduction in the clients’ hospital services utilization compared with the control group. However, no significant differences in the clients’ hospital services utilization exist between the two groups in the follow-up after 6 months.ConclusionHBRS of this study is an effective intervention service to improve health outcomes and reduce hospital services utilization among older people living in the community. Moreover, HBRS of this study was effective in reducing the caregivers’ caregiving strain.

Willingness to Pay for Home-Based Rehabilitation Service Among Older Adults.

This study aims to investigate the willingness to pay (WTP) for a home-based rehabilitation service and explore the influencing factors of WTP among older adults in Shanghai, China. A cross-sectional design was used. A questionnaire survey based on the contingent valuation method was conducted by face-to-face survey over 3 months. Only 242 (44%) participants were willing to pay for a home-based rehabilitation service. The median amount they were willing to pay was RMB 8 (US$1.15) per visit. Older adults who had higher monthly income, had at least one partner who worked, and had medical insurance were willing to pay more for the service. Older adults showed low WTP for a home-based rehabilitation service. Economic status and health condition are the significant influencing factors of WTP. Studies on recipients' precise needs and ability to pay are required before home-based services are implemented.